A CMS updated fact sheet stated the agency expanded its Compressive Primary Care Plus requirements to allow primary care physicians in certain Medicare accountable care organizations to participate, according to RevCycle Intelligence.
Here are seven highlights:
1. Of the total 5,000 primary care practices the CPC+ allows, up to 1,500 practices can participate in an ACO.
2. The update only allows primary care practices participating in the Medicare Shared Savings Program to be eligible for the program. CMS' CPC+ will begin in January 2017, and disqualifies practices that are a part of the Accountable Care Organization Investment Model, Next Generation ACO Model or any other shared savings program from being eligible to participate.
3. After a handful of healthcare stakeholders claimed limiting CPC+ participation would dissuade some practices from participating in ACOs, CMS modified their eligibility requirements.
4. The CPC+ model requires participants to offer:
• 24-hour access to care
• Proactive chronic disease management programs
• Better preventative care
• Enhanced coordination with other providers
5. Medicare and other payers will provide participating practices either monthly payments or advanced prepayments to aid in implementing primary care techniques. Practices will keep the financial incentives if they meet or exceed quality and utilization requirements or will have to pay it back if they fail to do so.
6. The modified payment program for ACOs has three parts, including:
• For practices participating in ACOs, they will receive a monthly care management fee and must give the CMS a letter signed by ACO leadership. The letter must state the ACO must separate the care management fees from shared ACO funds.
• Primary care practices within an ACO will participate in the ACO's shared savings and loss arrangement, as opposed to the CPC+ model providing a prospective or retrospectively reconciled payment.
• Some Medicare fee-for-service payments for evaluation and management will change to the Comprehensive Primary Care Payments. The payments will consist of a proportional reduction in payment for evaluation and management services.
7. CPC+ participation will not change ACO financial benchmark calculations.
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